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Proposed algorithm for detection of C. difficile in fecal specimens submitted for C. difficile testing. Tests used are C.DIFF CHEK-60 for C. difficile specific antigen (glutamate dehydrogenase) and TOX A/B QUIK CHEK for toxin A/B (both TechLab/Wampole). The percentage values refer to the total numbers of stool specimens analyzed (n = 1,468). Results for nine specimens (0.6%) which did not fit into the described categories are not included.

↵a The toxigenicity of C. difficile isolates was determined by PCR for the presence of tcdA and tcdB genes of toxin A and B. Only specimens for which culture isolates were available were included in this analysis. NPV, negative predictive value; PPV, positive predictive value; 95% CI, 95% confidence interval.